Provider Demographics
NPI:1750505632
Name:WEYMOUTH DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:WEYMOUTH DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-335-1576
Mailing Address - Street 1:130 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2337
Mailing Address - Country:US
Mailing Address - Phone:781-335-1576
Mailing Address - Fax:781-335-8401
Practice Address - Street 1:130 BROAD ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2337
Practice Address - Country:US
Practice Address - Phone:781-335-1576
Practice Address - Fax:781-335-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11473122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0110OtherDELTA DENTAL
MA821971OtherUNITED CONCORDIA
MAX11032OtherBLUE CROSS BLUE SHIELD